MEDICARE: EAGLES WINGS HOME HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1003770587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLES WINGS HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	3515 W STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-1724
Country	:	US
Telephone Number	:	260-699-7149
Fax Number	:	260-279-2405

Provider Business Practice Location Address
First Line	:	3515 W STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-1724
Country	:	US
Telephone Number	:	260-699-7149
Fax Number	:	260-279-2405

Authorized Official
Title or Position	:	OWNER
Name	:	OLAOLUWA OLAIYA
Credential	:
Telephone Number	:	260-699-7149

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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